CMS offers 10 ICD-10 facts
Last week the Centers for Medicare and Medicaid Services (CMS) offered five facts to keep everyone focused on the ICD-10 truth. This week they supplemented the list with five more facts.
Now we have a list of 10 ICD-10 facts to focus on:
The ICD-10 transition date is October 1, 2015.
The government, payers, and large providers alike have made a substantial investment in ICD-10. This cost will rise if the transition is delayed, and further ICD-10 delays will lead to an unnecessary rise in health care costs. Get ready now for ICD-10.
You don’t have to use 68,000 codes.
Your practice does not use all 13,000 diagnosis codes available in ICD-9, nor will it be required to use the 68,000 codes that ICD-10 offers. As you do now, your practice will use a very small subset of the codes.
You will use a similar process to look up ICD-10 codes that you use with ICD-9.
Increasing the number of diagnosis codes does not necessarily make ICD-10 harder to use. As with ICD-9, an alphabetic index and electronic tools are available to help you with code selection.
Outpatient and office procedure codes aren’t changing.
The transition to ICD-10 for diagnosis coding and inpatient procedure coding does not affect the use of Current Procedural Terminology (CPT) for outpatient and office coding. Your practice will continue to use CPT.
All Medicare Fee-For-Service providers have the opportunity to conduct testing with CMS before the ICD-10 transition.
Your practice or clearinghouse can conduct acknowledgement testing at any time with your Medicare Administrative Contractor (MAC). Testing will ensure that you can submit claims with ICD-10 codes. During a special acknowledgement testing week to be held in June 2015, you will have access to real-time help desk support. Contact your MAC for details about testing plans and opportunities.
If you cannot submit ICD-10 claims electronically, Medicare offers several options.
CMS encourages you to prepare for the transition and be ready to submit ICD-10 claims electronically for all services provided on or after October 1, 2015. But if you are not ready, Medicare has several options for providers who are unable to submit claims with ICD-10 diagnosis codes due to problems with the provider’s system. Each of these requires that the provider be able to code in ICD-10:
- Free billing software that can be downloaded at any time from every Medicare Administrative Contractor (MAC)
- In about ½ of the MAC jurisdictions, Part B claims submission functionality on the MAC’s provider internet portal
- Submitting paper claims, if the Administrative Simplification Compliance Act waiver provisions are met
- If you take this route, be sure to allot time for you or your staff to prepare and complete training on free billing software or portals before the compliance date.
Practices that do not prepare for ICD-10 will not be able to submit claims for services performed on or after October 1, 2015.
Unless your practice is able to submit ICD-10 claims, whether using the alternate methods described above or electronically, your claims will not be accepted. Only claims coded with ICD-10 can be accepted for services provided on or after October 1, 2015.
Reimbursement for outpatient and physician office procedures will not be determined by ICD-10 codes.
Outpatient and physician office claims are not paid based on ICD-10 diagnosis codes but on CPT and HCPCS procedure codes, which are not changing. However, ICD-10-PCS codes will be used for hospital inpatient procedures, just as ICD-9 codes are used for such procedures today. Also, ICD diagnosis codes are sometimes used to determine medical necessity, regardless of care setting.
Costs could be substantially lower than projected earlier.
Recent studies by 3M and the Professional Association of Health Care Office Management have found many EHR vendors are including ICD-10 in their systems or upgrades—at little or no cost to their customers. As a result, software and systems costs for ICD-10 could be minimal for many providers.
It’s time to transition to ICD-10.
ICD-10 is foundational to modernizing health care and improving quality. ICD-10 serves as a building block that allows for greater specificity and standardized data that can:
- Improve coordination of a patient’s care across providers over time
- Advance public health research, public health surveillance, and emergency response through detection of disease outbreaks and adverse drug events
- Support innovative payment models that drive quality of care
- Enhance fraud detection efforts
No word on if we're going to get five more facts next week.
Here's another take on CMS' five ICD-10 facts:
- "Medicare offers options for those who can’t submit electronically"
- "Only claims using the new coding system will be accepted after the ICD-10 transition deadline"
- "ICD-10 codes do not decide reimbursement for physician office and outpatient procedures"
- "The costs of upgrading to the new coding system by the ICD-10 transition deadline are much lower than expected"
- "The time has come to move to the ICD-10 coding set"
- Claims with a date of service before Oct. 1 will need ICD-9 codes even if the claims are submitted after Oct. 1
- Claims with a date of service after Sept. 20 must use ICD-10 codes.
Medical claims with more than one code set will not be accepted.
- A medical claim can either have ICD-9 codes or ICD-10 codes.
- More than one medical claim may be submitted.
What I found interesting:
- 28 percent of responding hospitals have conducted ICD-10 revenue impact testing with healthcare payers.
- 67 percent of responding hospitals have conducted ICD-10 testing with clearinghouses.
United Audit Systems, Inc. (UASI) has been conducting ICD-10 gap analysis for three years and concluded that the Centers for Medicare and Medicaid Services (CMS) will deliver on its revenue-neutral projections. (Journal of AHIMA)